Anemia in Central-Asia Pre-School Children: Definition, Risk Factors and Evaluation of Home Fortification Intervention

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INTRODUCTION: Anemia has been a major public health problem for pre-school children in Asia for decades. This dissertation is concerned with understanding the persistent public health problem of anemia in Central Asia. First, by modeling the relationship between hemoglobin and altitude, we develop an Asian based highaltitude correction factor for hemoglobin to accurately identify anemia. Second we examine the risks for anemia in a group of pre-school aged children in the Central Asian Republic of Kyrgyzstan to gain insight into the possible causes of anemia. Finally, we evaluate the cost-effectiveness of a home-based fortification method "Sprinkles" to treat and prevent anemia in Central Asian preschoolers. DESIGN: For the first analysis, Demographic and Health Survey data from women 15-49 and children 6 to 36 months old were used. Data for the second and third analyses were taken from a random sample of children 6 to 36 months residing in the Naryn region of the Central Kyrgyzstan. Cost data for the third study were collected retrospectively and combined with the results of the impact of Sprinkles on hemoglobin levels to produce the cost-effectiveness ratio of the cost per child per 1g/L change in hemoglobin. RESULTS: The Asian-based altitude correction factors for hemoglobin produced more moderate adjustments, above 1000 meters, than correction factors derived based on non-Asian populations. Risk factors associated with anemia included several dietary variables as well as socio-demographic variables. Nearly two-thirds of the children had some level of anemia, 6% of which was severe. Finally, the cost of a weekly dosage of Sprinkles per child was $8.16 and the cost effectiveness was $1.36 per child per 1 g/L change in hemoglobin. CONCLUSIONS: Monitoring and evaluation of anemia in Central Asia should begin with an Asian-based correction factor for altitude to identify the prevalence of anemia. Risk factors associated with anemia in Kyrgyz preschool children were age, intake of meat, breast-milk, fruit and biscuits. Anemia risk was highest among younger children less than 24 months old. Further, a weekly dosage of Sprinkles is a costeffective method of delivering iron to central Asian children to reduce or prevent anemia.
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